Driving Better Quality of Care While Lowering Costs for Millions of People

Contributing experts: Salma Khaleq and Ariel Bayewitz.

In 2023, healthcare spending in the U.S. climbed to $4.8 trillion, accounting for roughly 18% of the gross domestic product, yet Americans experience poorer health outcomes compared to other high-income countries.

Healthcare payers can help eliminate that disconnect between spending and health outcomes with payment arrangements that recognize and incentivize clinical excellence, efficiency, and positive patient experiences.

Our value-based care programs accomplish that using industry-standard metrics and market-specific benchmarks for Medical Loss Ratio (MLR) and Healthcare Effectiveness Data and Information Set (HEDIS) performance.

We work with many high-performing large care provider groups and systems across the country in shared-risk value-based arrangements, but we recognize that shared-risk arrangements may not be the right value-based model for smaller, independent provider practices. One way we support these smaller-scale organizations is to make it possible for them to contract with National Value Partners that, in turn, act as accountable care organizations in shared-risk arrangements with our affiliated health plans.

National Value Partners assume financial risk on behalf of independent care providers and enable the care provider to better manage patient populations through data and analytical insights and workflow transformation support while minimizing any potential financial burden from unexpectedly high medical costs.

How Partnership Helps Connect Thousands of Families to Vital Resources

PM Pediatric Care, the nation’s largest pediatric urgent care provider and leader in behavioral health, received a 2024 Points of Light award by KLAS Research. This award recognizes PM Pediatric Care's efforts — in partnership with Elevance Health and Findhelp — in identifying social health disparities and connecting thousands of families to vital resources for healthier living.

With the implementation of the Social Drivers of Health Provider Incentive Program (SDoHPIP) in 26 offices across five states, PM Pediatric Care was able to systematically identify social health disparities among patients with Medicaid plans.

The SDoHPIP incentivizes care providers to deeply understand the social health needs of their patients. This enables health plan affiliates to connect members to essential resources, ultimately improving health outcomes, reducing disparities and emergency room visits, and lowering overall healthcare costs.

Using a National Value Partner Strategy Leads to Improved Care Provider and Patient Experiences

The latest Star Ratings reported in 2024 show improved outcomes for National Value Partners who had 33.8% higher Medicare Star results compared to non-value-based care groups and 8% higher results compared to other value-based care groups.¹

Value-based care can provide significant benefit to care providers in the form of better visibility into and less volatility in medical cost, improved patient experience, and expanded patient access to care. In its third year, our National Value Partners strategy results show the following health outcomes.

Health Measures for Members With NVP Value-Based Care Providers Versus Non-Value-Based Care Providers

National Value Partner (NVP) care providers perform noticeably better than their non-value-based care peers in Healthcare Effectiveness Data and Information Set (HEDIS®) measures.² These clinical quality measures reflect effective preventive care, leading to potentially fewer illnesses and complications from chronic disease.

For example, these charts show a comparison of quality performance by National Value Partners to non-value-based peers across all lines of business.

Quality and cost performance is embedded in the results ranking order when members search for care using our Find Care tool. In 2024, there were 2.3 million searches using Find Care, which translated into 21% of our members visiting primary care physicians who deliver higher-quality, lower-cost care.³

Improved Medication Adherence and Cost Transparency Depends on
Value-Based Care Networks

Our affiliated health plans’ value-based care networks integrate metrics across medical and pharmacy, which provides a wider view of members’ health. They incentivize care providers to prescribe on-formulary and in alignment with our evidence-based drug tiering to help prevent avoidable costs. These measures alone drive a $98 per-member-per-month savings in all-cause medical spending.⁴

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It’s an exciting time to be involved in the Elevance-Physician partnership through the Aledade ACO! We are making progress towards our shared goals of improving quality of patient care and reducing total healthcare costs by focusing on increasing primary care spending. The future looks even brighter still! Through trust, partnership, and mutual respect, we are on the cusp of achieving enormous benefit for Elevance Health, Aledade, primary care physicians, and most importantly, our patients!

Laura Theis, MD,

President, Central Coast Family Care, California

Value-based care partnerships result in significant healthcare quality enhancements and cost reductions, improving medication adherence by 7% to 10% and saving $1,200 annually per member.⁵

CarelonRx, our affiliated pharmacy benefit manager, offers Elevance Health care provider partners the opportunity to support comprehensive, patient-centered care through their patients' pharmacy benefits.

CarelonRx clinical pharmacists work with employer clients and their brokers and consultants to offer strategies for pharmacy benefit design, formulary management, and medication management programs, which improve price transparency and whole health, resulting in cost savings and quality improvements.